Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Weighing the Evidence and the Options: Spectrum of Care
What if the “gold standard” isn’t the only standard that delivers real results? We sit down with guest editor Dr. Emma Read to explore Spectrum of Care, the evidence-based approach that empowers veterinarians to present a range of medically sound options tailored to each client’s budget, lifestyle, and ability to follow through. Instead of treating alternatives as compromises, we show how tiered choices reduce moral distress, expand access to care, and still protect outcomes for pets.
Emma takes us inside the new JAVMA supplemental issue, where educators and clinicians map out how to teach Spectrum of Care so graduates don’t have to learn it the hard way. We dig into student takeaways, from recognizing privilege to practicing clear, empathetic conversations that align treatment with client goals. We also spotlight practical tools like communication frameworks and a Spectrum of Care video toolkit that make it easier to identify options, set expectations, and document decisions without shame or confusion.
Research is the next frontier. Many effective, lower-cost protocols live only in clinics and memories. We talk about turning those real-world methods into published evidence, partnering with veterinary schools to design studies, and building a shared knowledge base that separates tradition from what truly works. Along the way, we touch on business models that support tiered care, strategies to track outcomes, and the mindset shift that helps teams feel capable rather than constrained.
Curious how to bring Spectrum of Care into your practice or your classroom? Press play, then subscribe, share with a colleague, and leave a review to help more veterinarians find these tools and stories.
JAVMA editorial: https://doi.org/10.2460/javma.263.s3.s4
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SPEAKER_01:This is Veterinary Vertex, a podcast of the AB May Journal. This episode we chat about the Japan Spectrum of Care Supplemental Issue with our guest, Emma Reed.
SPEAKER_03:Welcome everyone. I'm editor-in-chief Lisa Fordier, and I'm with co-host, associate editor Sarah Wright. Emma, I know this is a super crazy time of busy time of year with the students coming back, so thank you so much for taking time out of this hectic time to be with us here today. Thank you very much for having me.
SPEAKER_01:So, Emma, you're our guest editor for the Javma Spectrum of Care supplemental issue. What can our readers expect to take away from these articles?
SPEAKER_02:Uh so I think first and foremost is understanding what spectrum of care actually is. And a lot of people say, well, spectrum of care is nothing new. It's something I've been practicing forever. And they're right. I think what is new about spectrum of care is the emphasis that we're placing on it and some of the solutions that we're looking for to be able to provide it and how best to use it, and also how best to teach it. And also some of these articles explore what are things that are good about spectrum of care for the profession. Um, and I think that's something that we have never considered before is are there things about spectrum of care that are good for us, not just good for our clients or the pets that we look after.
SPEAKER_03:I think that's a really good point. And thank you for defining what it is uh to start with. And you know, certainly some of the maybe more the rural practitioners knew how to practice it more than uh Ivy League. Um, and really it's hard to teach it in academia because people come to us once they have gotten past spectrum of care, spectrum of care, spectrum of care. Yeah, absolutely.
SPEAKER_02:And I think uh for those that are sitting there thinking, I'm in the dark about what the spectrum of care thing is, the idea is behind providing the broadest range of possible diagnostic and treatment options available, obviously, that are evidence-based or good medicine for a particular pet and for a particular client. So not every client is going to have the same resources, the same lifestyle, the same ability uh to manage their patient. And so it's really sort of trying to tailor make or personalize that care for both that client and the pet. And that requires some uh innovation. It requires some very uh thoughtful planning sometimes and uh broad knowledge, but it also requires the ability to really listen to that client and understand what's important to them and what it is they need.
SPEAKER_03:Can you expand a little bit? I really like what you said earlier about how rewarding it can be to us as the veterinarian to learn how to practice spectrum of care.
SPEAKER_02:So there's some work, and that comes out in in some of these articles, just talking about how morally distressing it is sometimes for veterinarians when you're you're faced with an animal that you know you could do something for, um, but the client can't afford it or can't provide the care uh that you would believe to be, and we always use that term gold standard. You know, sometimes we used to emphasize really teaching students this is the best way to manage this. And then people leave and go out and practice, and they have in their head there's sort of one best way to manage this. And if I don't do that, I'm providing substandard care. And the idea behind spectrum of care, then you have a range of options that are good medicine, and so it's not one option or nothing, it's a range of things that you can provide. So you can work with the client to do something good for the patient, and that tends to ease a lot of that distress that we feel as veterinarians. Like I have this patient in front of me, I know I can fix it, but yet I can't. And in this case, it's like I know I can't do the gold standard, but I still can do something that is good for that patient and for that client.
SPEAKER_03:And I love too how the idea of teaching this in veterinary schools, so it doesn't take decades for a veterinarian to acquire that information.
SPEAKER_02:Yeah, absolutely. And I think um there are there are also a couple articles in this edition that really address how we teach it. Uh, so what are the elements or components that go into teaching it? And what um what does it do for students when we teach it? And uh there's a particularly nice article that uh Lydia Alvarez and her group at Wisconsin did that looks at sort of the outcomes for students and what what they get out of it. Um so they learn things like, wow, I'm in a real position of privilege. You know, I I had a very privileged life. Um, I've maybe not thought about veterinary medicine or caring for my pet from a different perspective. What if I didn't have the resources? What if I didn't have that kind of housing or that kind of money or all those things? And so it it's creating um a different kind of practitioner when they get out of there. And as you said, Lisa, that means they don't have to go through the school of hard knocks to uh to figure it out like most of us did.
SPEAKER_03:Sure did. You've said a couple of times the work, the evidence. I think some listeners might be surprised to know that this is a research topic. Uh the what what sparked your research interest in spectrum of care?
SPEAKER_02:Yeah, so for me, I've been uh dabbling in educational research or kind of social research for um a long time now. And all kind of along the same vein for me is trying to create more confident, competent practitioners uh when they would leave, whether that's clinical skills or professional skills or in this case, spectrum of care. But we not only should be doing this the teaching in veterinary school, but then we should be researching it to see if what we're teaching and how we're teaching it actually makes a difference. Do they leave us more confident? Do they leave us more capable of doing the skills? Um, do they feel differently about themselves and about their ability when they get out into practice? Um, and I think in the past we just stood there and and taught them and felt like, well, I taught them, therefore they should know it. And now I think the emphasis really needs to be on I taught them and I taught them in this way, and did that make them better? And if not, could I change the way I'm teaching it to do it differently or better?
SPEAKER_03:Yeah, fantastic. As guest editor, uh, you suggested the topics, but you don't know exactly what they're going to write about. Uh, were there any surprising findings from the supplemental issue to you?
SPEAKER_02:I I think honestly, I really like all the papers. And I think what's surprising to me is that the collective of all of them really works. When you read them all back to back to back, one after another, I'm like, it it really tells a great story and shows the breadth of the the challenges and the things to think about around spectrum of care. And I think as a whole, they really work, although it wasn't deliberately planned out so. Um, and the one thing I also really appreciate is the spotlight articles that are in there about the different kinds of practice and how spectrum of care is practiced in that context, in that um practice situation. And the practitioners that wrote those, I think, did a wonderful job of highlighting how they use spectrum of care in their practice every day. And that really shows why it's important for us to be teaching it.
SPEAKER_03:Yeah, I was gonna say the same thing, and it just brought it all home. It really put the bow on the whole issue. Yeah.
SPEAKER_02:And I think that was your idea, actually, Dr. Fortier. So I can't take credit for that.
SPEAKER_01:I think it was our idea in my I think to me, one of the things that really stood out from this supplement is one of the videos actually is in it, that spectrum of care toolkit where identifying communicating evidence-based options to clients. I think that's a really novel way to showcase some of these techniques. I'm five years out of veterinary school and I can say I was not taught spectrum of care options. I went to the school of hard knocks of my internship, went from academia to private practice. We were located in a half affluent area, half impoverished area, and just seeing the diverse clientele really learned how to communicate properly the options to the people depending on what you're dealing with. Yeah. Yeah, you had to, right? Exactly. Exactly. Yeah. And for those of you just joining us, we're discussing the JAVMA spectrum of care supplemental issue with our guest Emma. So, Emma, what are the next steps for research in Spectrum of Care?
SPEAKER_02:Good question. I I think one of the things that we um are lacking in in a big way in spectrum of care is really building up that evidence for things that uh people have been doing to offer spectrum of care options for a long period of time that people have been doing out in practice, but we really don't have the accumulated evidence yet to show that they work. So, for example, practitioners will say, Oh, you don't need to do it that way, you can do it like this. And they'll have a shortcut or they'll have a way of doing it that does provide a really good option and seems to have a good outcome. And they've been doing it because they've used it and they know it works, but there's nothing published about it. And if they would um help be part of the literature and help publish some of those things, I think that would be a really great way to introduce that to others who would think, gee, I never thought of that. And for us to then be able to showcase those things and teach them to students, and so that we would have ways of doing things or ways of practicing that do have some evidence behind them. And sometimes we have taught generations that this is the way to do it, this is the only way to do it. And sometimes that's because we don't have evidence to the contrary. And when we actually look at it, and some of these articles speak to that, when we actually look at it, we find out, oh, that's not actually the only way to do it. And in fact, the outcome can be just the same, or maybe sometimes even better if we do it a slightly different way.
SPEAKER_03:How would you advise those veterinarians who are interested in spectrum of care? How do they reach out to you? They could reach out to me and Sarah and I can direct them into how to make one of these videos. How do they reach out to someone in academia to say, how can I help in spectrum of care?
SPEAKER_02:Yeah, so I know in um in our uh institution, obviously, we've had a fair um emphasis on spectrum of care. And so we do work with a number of practitioners, and we've had some of them on an advisory uh committee that work with our um spectrum of care clinic. But I think reaching out to your local veterinary school and saying, hey, I have this idea, I would like to get involved, um, and finding out if you compare with someone, because sometimes you're like, I'm in practice, I'm doing these things, but I don't have the time to write it up, or I don't have the know-how to put together a case series. And I think there are people at vet schools who would be interested in working with you and helping you. And but someone has to reach out first and get that partnership started.
SPEAKER_01:Very good. So we've shared why people should care about spectrum of care and why it's important, but what is one piece of information the veterinarian should know about the Java Spectrum of Care supplemental issue? What's that one big take-home message for them?
SPEAKER_02:Uh well, I sort of said it in my uh opening commentary that no matter what you call it, um, we all need it. So spectrum of care is going to impact different people differently depending on where they work in the profession. And I think I think we need to be open to the idea that all of us should and could practice spectrum of care. And that no matter what species you work on, and no matter what part of the industry you work in, um, spectrum of care is a really important concept that I don't think is going away and is one that we really need to work hard to embrace and teach in our students and help mentor young people to go into practice knowing how to do spectrum of care. And so I think no matter what you call it, and if you read that article, you realize there's all kinds of buzzwords that mean the same thing. No matter what you call it, we definitely need that.
SPEAKER_01:Now, on the other side of the relationship, what's one thing that clients should know about spectrum of care?
SPEAKER_02:Uh, well, definitely I think they need to know that there's not one single gold standard in many cases. And they also, I think some clients would feel better just for knowing that there are other clients out there who also cannot afford one single uh gold standard, if you will, and that a range of options is something that we should provide and is something reasonable many people need. And I think the other thing is they should know that there are a lot of people in the veterinary profession that care about trying to find and create a broader range, and also trying to find creative ways to help people access care. And so some of the articles in here actually even relate to the business side of spectrum of care and talk about we should be looking for different ways to help clients afford that care and and uh different models of doing business. And I think that clients would maybe appreciate that there are veterinarians and people in the industry that are very engaged and looking for new ways to do things.
SPEAKER_03:Very cool. As you wind down now, Emma, uh, we love to ask this question. I can see you're in your office, so we're looking for a good one here. What's the oldest or the most interesting item on your desk or in your desk drawer? How long have you been at that desk? Uh well, seven years here as an associate dean.
SPEAKER_02:However, I do have an old item here. If you know what this is, so this is no see no yeah, an enterlith uh taken out of the large intestine of a horse, small colon, actually. So first first one I ever took out as a surgery resident a long time ago, and uh of course it was the first one, so I was quite attached to it, and the intern wanted it, and I said no, because it was my first one, and then afterwards I thought, you know, I really need to share this. So I took it to a professional rock cutter, they cut it, they finished it, and I gave the intern her half for Christmas. I kept it, it's a paperweight on my desk.
SPEAKER_03:It's beautiful. What do you reckon that is? Seven inches in diameter? Uh yeah, yeah. That's a small colon. Wow. Yeah, yeah. How'd the horse do? Uh right, did fine, yeah.
SPEAKER_02:Did okay. From what I remember, that's a while ago.
SPEAKER_01:That's cool.
SPEAKER_02:Yeah.
SPEAKER_01:To our listeners that want to see Emma's cool entrelith, you can watch this episode on YouTube or on our website. Well, thank you so much, Emma. We appreciate you being here with us today, and we're super excited too to have you as the guest editor for this really interesting supplemental issue for Javma.
SPEAKER_02:Thanks very much, you guys, for having me. And uh hope the readers out there really enjoy this issue and learn lots from it.
SPEAKER_01:We hope so too. And to our listeners, you can read the Spectrum of Care supplemental issue in JAFMA. I'm Sarah with Lisa Fortier. Be on the lookout for next week's episode, and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
